Follow Your Gut: Differentiate Duodenal and Gastric Ulcers

For several years, gastroenterologists (stomach specialist) blamed stress and stomach acid for causing gastric ulcers. Later on, research revealed that peptic ulcers resulted from a Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs) usage. They have learned that prescribing antibiotic treatment could cure the H.pylori infection and prevent surgical intervention for ulcers.

Over all, individuals who should be concerned about developing an ulcer from pain medications are those these major risk factors such as age (over the age of 60 years), with a history of ulcer bleeding, and use of multiple medications particularly NSAIDs or other drugs including naproxen and warfarin (aspirin). Let’s take for instance Laura’s story.

Laura’s Story

Sixty-five year old *Laura Rosenthal was rushed to a nearby medical center last year due to perforated pain from an ulcer in her stomach. For several years, Mrs. Rosenthal had been prescribed with Celebrex (Celecoxib), an analgesic that help regulate chronic pain from arthritis. Aside from that, she takes a low dose aspirin two-three times a week. Both medications are drugs (NSAIDs), a type of painkiller that is used for moderate to mild pain. Other famous generic brands include naproxen and ibuprofen.

Although NSAIDs control arthritic pain, they are also known to cause digestive ulcers, predominantly in the stomach. NSAIDs work to pacify the inflammation, but they also impede the production of hormones that work to defend the digestive tract lining. Celecoxib is one of the safest analgesic pills for the stomach, but it can still pose a risk especially when you consume multiple kinds of NSAIDS altogether.

Mrs. Rosenthal was very lucky, she survived a duodenal ulcer perforation. If the doctors hadn’t sewed her up, her perforated ulcer can lead to peritonitis, a serious infection of the abdominal cavity that is caused by partially digested food and bacteria that spilled out of the perforated stomach. Other complications she might suffer include bleeding and obstruction due to the swelling and scarring.

Before Mrs. Rosenthal’s hospitalization, she did not feel major warning symptoms. She just experienced nausea and stomach pain the week before. (The most common ulcer symptom is burning pain in the abdomen which occurs early in the morning and between meals, which may last from minutes to hours.) Other ulcer symptoms include belching (burping), vomiting, unintentional weight loss due to poor appetite, and feeling tired and weak.

To prevent further stomach damage and relieve Mrs. Rosenthal’s arthritis symptoms, her doctors replaced her non-NSAID pain relievers and prescribed her on a proton pump inhibitor (works to reduce stomach acid secretion) indefinitely. Finally, the challenge with ulcers from NSAID use is that the preventive measures used available sometimes cannot disregard the risks. For Mrs. Rosenthal, many risk factors conspired against her. The risk factors to focus are her age and her NSAIDs use - taking Celecoxib and aspirin without the protection of a proton pump inhibitor (such as Omeprazole).

Gastric and Duodenal Ulcers: What’s the difference?

Peptic ulcer is a hollowed area that forms in the mucosal walls of the stomach, pylorus (opening between duodenum and stomach), the duodenum (first part of the intestine), and in the esophagus (the hollow tube that connects the throat to the stomach).

A peptic ulcer is referred to as gastric, esophageal and duodenal depending on its location.

The incidence of gastric ulcers usually occurs to males and females 50 years old and over whereas there are more males than females from 30-60 years old in the case of duodenal ulcers. Further, 80% of peptic ulcers occur in the duodenum and 15% are gastric cases.

Alcohol and NSAID use, smoking, amount of stress, history of H. pylori infection and gastritis (inflammation of the stomach) may predispose an individual to gastric ulcer. Then again, a history of liver cirrhosis, along with the other risk factors mentioned (except use of NSAIDS and gastritis) may increase the threat for duodenal ulcer.

Signs and symptoms also vary between gastric and duodenal ulcers. In gastric ulcer, stomach acid secretion is still normal while in duodenal, it is increased. Weight gain happens in duodenal ulcers while patients who have gastric ulcers experience unintentional weight loss. Both ulcers experience internal bleeding and manifests thru black, tarry stools (melena) and vomiting of blood (hematemesis). The most common symptom which is abdominal pain both occurs usually after meals for both ulcer types.

The challenge of managing ulcers due to different causes may sometimes be complex because of the interplay of multiple risk factors and health issues. The prescription of antibiotics and H2 blockers has greatly reduced the need for surgical treatment. However, surgical procedures are advised if ulcers do not heal after 12-16 weeks of medical treatment, and if the patient experiences life-threatening bleeding, perforation, obstruction and unresponsiveness to medications.

Surgical Procedures and Medical Centers for Stomach and Duodenal Ulcers

Vagotomy – severing (cutting) the vagus nerve (secretes stomach acid)

Truncal Vagotomy – severing of the right and left vagus nerve to decrease stomach acid secretion

Selective Vagotomy – severing of the stomach’s vagus nerve is performed leaving the vagal supply to other abdominal organs intact.

Gastric Vagotomy without drainage

Pyloroplasty – A longitudinal incision is made to the pylorus to enlarge and relax the muscle.

Billroth I (Antrectomy) – removal of the lower portion of the stomach along with small portions of the duodenum and pylorus

Billroth II (Subtotal Gastrectomy) - removal of the distal third portion of the stomach

Laparoscopic surgery - A laparoscope is a thin, long tube that has a camera attached to allow the gastroenterologist (stomach specialist) to examine the organs, assess for abnormalities and operate by making small incisions inside the abdomen. This type of diagnostic surgery may now be used to treat ulcers.

There are medical centers around the world that can offer surgical treatments to gastric and duodenal ulcers. Aside from price affordability, most of these centers offer logistic services for international travellers such as visa and travel assistance, hotel accommodation, food and shopping, airport and hotel transfers, sight-seeing and interpreter and cultural assistance. Communicating your medical needs will not be a problem as most of the medical and nursing staff are fluent in English. These centers are well-equipped complete with a diagnostic unit and laboratory, having passed ISO certifications and JCI accreditations. If you require multispecialty management because of your illness, you don’t need to worry as most of these medical centers are affiliated with board certified and experienced doctors and specialists.

PlacidWay is one of the leading medical tourism companies in the world that provides international travellers recent information about seeking healthcare alternatives abroad. Through a network of 250 healthcare facilities in 30 countries, PlacidWay connects affordable treatment options and international healthcare providers to medical travellers so that they can make the right healthcare decision based according to their needs, while they explore an exotic destination anywhere in the world.

If you have questions about medical centers and surgical procedures for Duodenal and Gastric Ulcers abroad, please do not hesitate to contact us!

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